Provider Demographics
NPI:1891427613
Name:BLUE SKY PEDIATRICS PLLC
Entity Type:Organization
Organization Name:BLUE SKY PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SAYAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:IMAGAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-229-0542
Mailing Address - Street 1:878 S DENTON TAP RD STE 250
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4565
Mailing Address - Country:US
Mailing Address - Phone:972-636-4016
Mailing Address - Fax:
Practice Address - Street 1:878 S DENTON TAP RD STE 250
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4565
Practice Address - Country:US
Practice Address - Phone:972-636-4016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty